Introduction : To grasp what kind of problems exists in order to solve the shortage of pathologists, we conducted a survey with special focus on the condition of facilities with single pathologists. We also considered whether the use of virtual slide technology is a viable option in mitigating the shortage of pathologists.
Methods : The survey was conducted at the 58th Autumn Annual Meeting of the Japanese Society of Pathology using questionnaires. Interviews were also obtained with pathologists who use virtual slides
Results : The percentage of facilities with single pathologists was approximately 30%, and these facilities had the highest rates of using virtual slides for remote pathology consultations. Regardless of the number of pathologist at a facility, outside consultation was often obtained with difficult cases. Although pathologists working alone expressed anxiety over diagnosing cancer, consulting other facilities appeared to be difficult.
Conclusion : In order to reduce the anxiety of pathologists working alone and to raise the accuracy of cancer diagnoses, a mechanism by which pathologists can consult each other is required. Developing a network for pathologists for such consultations using virtual slides is felt to be important in primary care.

Porokeratosis is a genodermatosis characterized by abnormal epidermal keratinization with the histologic finding of cornoid lamella. Porokeratosis of Mibelli may be autosomal dominant or sporadic. Currently, there is no established cure for this disease and few clinical trials have been published worldwide. We describe a case of a 56-year-old man with a seventeen year history of a solitary erythematous plaque with raised border along the left midaxillary line, originating from a papule which was burned by a cigarette. Review of skin punch biopsy which was initially read as keloid with signs of irritation showed columns of parakeratosis with underlying necrotic keratinocytes, consistent with porokeratosis. Topical 4% 5-fluorouracil in propylene glycol was applied twice daily which resulted in an inflammatory response after 3 weeks of use. This gradually resolved with notable decreased thickness of the plaque.

Human ; Male ; Middle Aged ; Biopsy ; Epidermis ; Fluorouracil ; Keloid ; Keratinocytes ; Parakeratosis ; Porokeratosis ; Propylene Glycol ; Skin ; Skin Diseases

Using near-infrared spectroscopy, we monitored changes of oxygenated hemoglobin and myoglobin contents [oxy (Hb+Mb) ], deoxygenated hemoglobin and myoglobin contents [deoxy (Hb+Mb) ], and total hemoglobin and myoglobin contents [total (Hb+Mb) ] of the thigh muscle at rest and during incremental bicycle exercise and recovery in 10 healthy male volnuteers. Gas exchange parameters were also measured in breath-by-breath mode.
The following results were obtained :
1) During low-intensity exercise (216 kpm/min), oxy (Hb+Mb) increased, while deoxy (Hb+Mb) and total (Hb+Mb) decreased. These changes are thought to reflect an increase in arterial blood flow to the exercising muscle and an increase in venous return.
2) During high-intensity exercise (above 972 kpm/min), oxy (Hb+Mb) decreased, while deoxy (Hb+Mb) increased. These findings probably reflect increased O₂extraction.
3) Upon cessation of exercise, oxy (Hb+Mb) and total (Hb+Mb) increased, and deoxy (Hb+Mb) decreased abruptly. These changes probably reflect post-exercise hyperemia with decreased O₂extraction.
4) Oxy (Hb+Mb) level at ventilatory threshold (VT) was the same as or higher than that of resting condition, indicating that VT occurs when the level of O₂in the vessels of the thigh muscle is relatively high.
5) Spontaneous fluctuation of oxy (Hb+Mb) with frequency of 7-10 cycles/min was observed. This fluctuation was more marked during exercise than during rest or recovery.
These findings suggest that the influence of increased blood flow and venous return on oxy (Hb+Mb), deoxy (Hb+Mb) and total (Hb+Mb) are greater than that of O₂extraction during low intensity exercise, whereas the influence of O₂extraction increases with exercise intensity.
Near-infrared spectroscopy provides valuable information with regard to O₂transport and O₂extraction in the exercising muscle.

A 26-year-old female patient with Type 1 Gaucher’s disease (GD) was admitted to our clinic with complaints of stomachache and signs of anemia. The patient underwent ultrasonography (US), computerised tomography (CT), and magnetic resonance imaging (MRI) scan. Imaging studies revealed massive hepatosplenomegaly, choledocolithiasis, and six nodules in the spleen with a mean size of 14 mm. The nodules appeared hyperechoic, hypoechoic, and of mixed echogenicity on the US and hypodense on the CT. While the nodules were observed to be iso-hypointense in T1-weighted (T1WI) images, they appeared to be hyperintense in the T2- weighted (T2WI) images. There were no diffusion restrictions in these nodules that appeared on the diffusion-weighted magnetic resonance imaging (DWI). A nodule located at the lower pole was observed to be hypointense in the T2WI images. The nodule located at the lower pole, which appeared hypointense in T2WI series, had restricted diffusion upon DWI. In this study, we aimed to present the properties of splenic GD nodules using US, CT, and conventional MRI, together with DWI. This case report is the first to apply US, CT, and conventional MRI, together with DWI, to the splenic nodules associated with Gaucher’s disease.

Objective: The purpose of this study was to examine the effects of Coenzyme Q10 (CoQ10) supplementation on salivary secretory immunoglobulin A (SIgA) and health-related Quality of Life (QOL) in middle-aged and elderly individuals. Methods: Sixty healthy middle-aged and elderly individuals were assigned randomly to a CoQ10 supplementation group (n = 30) or a placebo supplementation group (n = 30) using a double blind method. Subjects took 150 mg CoQ10 or placebo per day for 8 weeks. Salivary SIgA secretion rate and SF-36 test (physical and mental health-related QOL) were determined before and after the intervention. Results: CoQ10 group showed that a tendency to increase of salivary SIgA secretion rate (p = 0.08), although placebo group did not show significant change. Physical health-related QOL did not significantly change in both groups. Vitality and mental health scores, which were subscale of mental health-related QOL, were significantly increased after the intervention in CoQ10 group (p < 0.05), although placebo group did not show significant change. Conclusion: 8 weeks of CoQ10 supplementation may bolster SIgA-mediated oral immunity and mental health-related QOL in middle-aged and elderly individuals.

A 47-year-old man was referred to our hospital for multiple rib fractures and pneumohemothorax due to a traffic accident. After admission, tricuspid valve regurgitation and hypoxemia were also diagnosed. Although fixation of the fractured ribs with plates and removal of hematoma in the pleural cavity were performed, hypoxemia did not improve. He was discharged on home oxygen therapy. Ten months and 3 years after the traffic accident, pulmonary perfusion scintigraphy suggested a right-to-left shunt. Transesophageal echocardiography demonstrated an opening of the foramen ovale and a right-to-left interatrial shunt. Direct closure of the patent foramen ovale and tricuspid valve replacement with the Carpentier-Edwards bioprosthesis were performed and hypoxemia disappeared after the second operation. Traumatic tricuspid valve regurgitation with cyanosis is extremely rare. However, it is important to take the possibility of patent foramen ovale into consideration in patients with traumatic tricuspid valve regurgitation and cyanosis.

An 82-year-old man was taken to a local clinic following the occurrence of syncope. Chest roentgenography and computed tomography (CT) findings led to a suspicion of a ruptured aortic aneurysm, and the patient was immediately transferred to our hospital. Upon admission, his consciousness was clear and blood pressure was 74/47mmHg. Enhanced chest CT images demonstrated pericardial effusion and a saccular aneurysm with a maximum diameter of 5cm, which was associated with a thrombus in the distal aortic arch. An emergency operation was performed under a diagnosis of a ruptured distal aortic arch aneurysm and hemorrhagic cardiac tamponade. During the procedure, a hole was found in the lesser curvature of the aneurysm, which had directly ruptured into the pericardial space, and a graft replacement of the aortic arch was performed using selective cerebral perfusion. The patient was discharged 19 days after surgery without any postoperative complications.

Ten athletic women (5 normal ovulatory cycles, 5 short luteal phases) and 6 non-athletic women with normal ovulatory cycles were subjected to an investigation of episodic gonadotropin secretion. In the middle follicular phase, blood samples were obtained via an indwelling venous catheter every 15 minutes for 4 hours.
Mean levels of gonadotropins in both athletic groups were lower (p<0.001) than in the control group. LH pulse frequencies in the short luteal group were significantly lower than in the control group (p<0.001) . LH pulse amplitudes were similar in all groups. FSH dynamics were the same as those for LH.
In athletic women, low mean levels and infrequent episodic secretion of gonadotropins were obvious. These data suggest that strenuous athletic activity may cause hypothalamic-pituitary insufficiency, especially that of hypothalamic origin.

Athletic women often exhibit menstrual disorders such as luteal insufficiency, oligomenorrhea and amenorrhea are often seen. It has been suggested that such disorders are related to prolactin release caused by physical activity. To investigate the mechanism by which the disorders are promoted, prolactin secretion was studied in 10 athletic women (5 with normal ovulatory periods, and 5 with short luteal periods) and 6 non-athletic controls. Blood samples were obtained during the early follicular phase of the menstrual cycle through an indwelling venous catheter at 15-minute intervals for 4 hours. The concentration of prolactin was measured by radioimmunoassay.
The mean prolactin concentration in the athletic group was lower than that in the control group (p<0.001), and pulse frequency in the athletic group was higher than that of the control group (p<0.01) . Pulse amplitude in the athletic women with short luteal periods was higher than that of those with normal ovulation. Pulse duration in the athletic women with short luteal periods was significantly longer than that of those with normal ovulation (p<0.01) .
These findings suggest that prolactin is one of the most important factors in menstrual disorders in athletic women.

Erythema elevatum diutinum (EED) is a rare, chronic leukocytoclastic vasculitis characterized by erythematous to violaceous plaques and nodules, typically on extensor surfaces like the hands, elbows, and knees. It results from immune complex deposition in blood vessels, leading to inflammation and fibrosis. EED is often associated with infections, autoimmune disorders, or hematologic malignancies, but can also occur idiopathically. Although globally documented, EED is extremely rare in the Philippines, particularly in adolescents, highlighting its significance in local literature.

A 14-year-old Filipino female presented with a 5-month history of asymptomatic, skin-colored papules on her right elbow, gradually spreading to both elbows and knees, with occasional mild pruritus and knee joint pain. Past medical and family history were unremarkable. After temporary relief from an unrecalled cream prescribed by a private dermatologist, she was referred for skin punch biopsy, which revealed spongiotic epidermis with papillary dermal edema, moderate inflammatory infiltrates, eosinophilic inclusion bodies, and nuclear dusts surrounding the blood vessels, consistent with EED. The patient was treated with dapsone 50 mg/day, clobetasol propionate ointment twice daily for two weeks, and cetirizine 10 mg as needed for pruritus, resulting in clinical improvement.

This case highlights the extreme rarity of EED in the Philippines, particularly in adolescents. It emphasizes the need to consider EED in chronic papular eruptions and demonstrates the effectiveness of dapsone and topical steroids in managing the condition. Early diagnosis and timely intervention are crucial for preventing disease progression and improving patient outcomes, as seen in this case.

Human ; Female ; Adolescent: 13-18 Yrs Old ; Adolescent ; Erythema Elevatum Diutinum ; Leukocytoclastic Vasculitis